title: Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation.
abstract: It is critical to balance waitlist mortality against posttransplant mortality. Our objective was to devise a scoring system that predicts recipient survival at 3 months following liver transplantation to complement MELD-predicted waitlist mortality. Univariate and multivariate analysis on 21,673 liver transplant recipients identified independent recipient and donor risk factors for posttransplant mortality. A retrospective analysis conducted on 30,321 waitlisted candidates reevaluated the predictive ability of the Model for End-Stage Liver Disease (MELD) score. We identified 13 recipient factors, 4 donor factors and 2 operative factors (warm and cold ischemia) as significant predictors of recipient mortality following liver transplantation at 3 months. The Survival Outcomes Following Liver Transplant (SOFT) Score utilized 18 risk factors (excluding warm ischemia) to successfully predict 3-month recipient survival following liver transplantation. This analysis represents a study of waitlisted candidates and transplant recipients of liver allografts after the MELD score was implemented. Unlike MELD, the SOFT score can accurately predict 3-month survival following liver transplantation. The most significant risk factors were previous transplantation and life support pretransplant. The SOFT score can help clinicians determine in real time which candidates should be transplanted with which allografts. Combined with MELD, SOFT can better quantify survival benefit for individual transplant procedures.
authors.affiliation: Division of Abdominal Organ Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA. aar2107@columbia.edu
authors.forename: A
authors.initials: A
authors.lastname: Rana
authors.forename: M A
authors.initials: MA
authors.lastname: Hardy
authors.forename: K J
authors.initials: KJ
authors.lastname: Halazun
authors.forename: D C
authors.initials: DC
authors.lastname: Woodland
authors.forename: L E
authors.initials: LE
authors.lastname: Ratner
authors.forename: B
authors.initials: B
authors.lastname: Samstein
authors.forename: J V
authors.initials: JV
authors.lastname: Guarrera
authors.forename: R S
authors.initials: RS
authors.lastname: Brown
authors.forename: J C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists; D052096:Warm Ischemia